ARC East of England researchers worked with families, carers, and schools to increase access to timely mental health support by training primary school staff in a holistic, evidence-based approach to help children with anxiety.
The Working on Worries project has now supported 189 families to reduce the impact of anxiety on children so they can progress towards their goals at school.
Anxiety problems are the most prevalent mental health difficulties in childhood linked with poor school attendance, reduced academic performance and lower life satisfaction. Early intervention and support can help children develop skills to better manage their lives and promote good mental health. Schools and families are ideally placed to recognise when children and young people require this support, but need more resources, support, and training to effectively intervene. Local mental health staff started Working on Worries (WoW) in 2019 to respond to these needs identified by staff from the Nebula Federation of schools in Norfolk.
The team led by Dr Tim Clarke developed a pilot programme to train Nebula pastoral staff to deliver a proven evidence-based intervention called Helping Your Child - Parent Led Cognitive Behavioural Therapy (PL-CBT) and worked with Ormiston Families to train and support school staff. WoW developed from the findings of this pilot to expand the approach across Norfolk and Waveney, providing support for children and families to address fears and worries without the need for external mental health referrals.
Children, parents and carers, and school workers have been involved throughout the design and delivery of this project, with representatives from the education sector and a peer researcher engaged in the core project team. A Parent and Carer Advisory Group (PCAG) was established to advise and guide the project by sharing children’s perspectives, and they have developed materials to help schools recruit families to try the WoW approach, adapted training, and ensured data collection tools are accessible to parents and children.
This project is bringing children and young people’s mental health and education systems together and helping the wider system to work collaboratively in providing support and advice to primary school staff offering the intervention. A Stakeholder Steering Group was convened with representatives from the education sector, mental health service providers, commissioners, local authority services, parents and carers to guide key decisions throughout the project and development of the implementation strategy. Feedback from trained school staff and parents/carers has led to critical changes in training delivery and support sessions.
Project lead Dr Tim Clarke progressed the development and delivery of this approach with support from an ARC East of England Implementation Fellowship. Tim said: “Training primary school support staff to deliver parent-led CBT has expanded access to an evidence-based intervention for child anxiety. This intervention was previously only accessible to families following a referral to an external mental health service, but can now be delivered directly in schools without the need for families to be placed on long waiting lists.
"By enhancing the offer of support available within schools, we hope to see a reduction in referrals from schools to external services for cases of child anxiety. In turn, this will alleviate capacity and demand pressures faced by NHS services. We have offered support and advice regionally and nationally to help develop and implement similar models.”
Dr Tim Clarke, ARC East of England mental health researcher
Over the course of the project, 216 staff have been trained in 125 primary schools to help 189 children manage anxiety problems. The team has not collected data on sickness and absences, but feedback received from school staff and parents does mention improved wellbeing and attendance as a result of Working on Worries. Preliminary outcomes show a positive reduction in anxiety and progression towards goal-based outcomes which is comparable to interventions delivered by mental health services.
Feedback from children and parents in response to the parent/child feedback survey has reported an overwhelmingly positive impact overall. Parents/carers have noted a tangible change in their children, with them seeming more confident and open. Parents also feel more confident in helping their children, with a better grasp of anxiety and how to address it. They also report that the training has had an impact on the family as whole, not just the children. They feel the intervention is easy to understand and simple to use, and they also report that they appreciated the choice of intervention style. For children, our survey utilised emojis to collect responses and they reported positive feelings about the intervention and being helped by their parents.
“She has the tools to work on problem solving her anxiety and worries. She is never going to be a child that loves school BUT this has given her the ability to look at the worry of going in and leaving me and break it down into steps she can complete. She’s worked so well on her step plan and I can see (and other people at the school gates) can see the difference in her going in each day.”
Parent of a child helped by Working on Worries
Feedback from trained school staff was collected through surveys, case studies, and focus groups. When families successfully engaged with Working on Worries, school staff reported that they observed positive outcomes. They noticed positive changes in the children who seemed more confident and less anxious. Case studies report better engagement in class and school activities. Staff have reported that they appreciate how working with the parents reduces the need for children to leave class to receive the intervention. Following Working on Worries, children have been observed to be happier in the school environment. Furthermore, staff have reflected that the intervention has transformed how they interact with children at school, using strategies from the intervention to assist children who are experiencing heightened emotions and to better understand the difficulties and worries children face in the classroom.
“[The intervention] takes pressure off school staff and alleviates the need to take the child out of lessons, but also empowers parents to understand and support their child’s anxiety more effectively, thus increasing the likelihood that the benefits of the intervention will continue far beyond the duration of the intervention.”
School pastoral staff member
The Working on Worries project has formed key cross-system partnerships across education, mental health, NIHR, patient and public involvement, commissioning, and academia. They have worked closely with the NIHR to help shape, develop and sustain the project with funding from the Mental Health Implementation Network (MHIN). NIHR ARC East of England provided support for the original funding application and ongoing advice. Funding from NHS Norfolk and Waveney Integrated Care Board (ICB) has extended the programme to continue training and supporting primary school staff to deliver parent-led CBT. Other project partners have included the University of Oxford, Norfolk and Suffolk NHS Foundation Trust, Norfolk County Council, Ormiston Families, Cambridge Community Services NHS Trust, Nebula Federation and Norfolk School Leaders Association.
The main challenge for this project was creating a consistent yet flexible implementation programme that suited the variable needs and capacities of the schools taking part. To overcome this, they collected feedback and comments from schools and trained staff throughout the project. They ensured that schools had the freedom to tailor Working on Worries for their specific context, and adapted training and support mechanisms to better suit individuals involved. School staff were trained to deliver two variations of the approach and could choose to apply one or both in their schools to meet needs. The project team used an implementation science framework to coproduce implementation plans with primary school staff which helped to identify potential barriers and develop strategies to mitigate these issues.
Outcomes and learning from the initial phase of the project were presented at the MHIN national dissemination event in March 2024. With further funding granted by the MHIN, the team will continue to evaluate the project and develop an implementation guidance document and toolkit in partnership with the North West Coast healthcare and education system. This will use findings from the initial phase of the project to support the delivery of parent-led CBT in primary schools by both school support staff and mental health support in other regions. The project team have also provided local, national, and international teams with advice while they develop their own PL-CBT programmes.
- If you would like to learn more about this project or collaborate with the researchers, please contact: workingonworries@nsft.nhs.uk.
- Any parents, school workers and healthcare staff with experience of delivering or receiving the Working on Worries intervention are invited to help develop the implementation guide and toolkit by completing this online survey.
